Expert Q&A: Heart-Healthy Eating

What are plant stanols/sterols, how do they work, and where can you find them?

These phytosterols are essential components of plant membranes. They
resemble the chemical structure of cholesterol. They are present in small
quantities in vegetables and fruits and nuts and berries and so on, and they
lower your blood cholesterol.

They seem to work by affecting both the absorption of the food and the
processing of it. Plant sterols help lower LDL cholesterol by blocking its
absorption. They compete with cholesterol in the digestive tract in the
formation of micelles, the tiny particles that your body uses to transport
cholesterol and absorb it through the intestinal wall.

I don't want people to think, "I'll just take plant stanols and sterols
and that will do it." Lowering cholesterol is a combination of several
things that don't just add up but that are synergistic as well.

How will a diet rich in soluble fiber and plant stanols affect statins? Is it safe to take both?

I don't think you can get your cholesterol too low through diet and
lifestyle. Cholesterol is not bad, it's just that we just get too much of it.
Cholesterol is an essential building block. Because it is essential, the
dietary requirement is zero because your body will always make all it
needs.

It is possible you can get your cholesterol level too low through drugs. It
is part of the reason why, if you can sufficiently lower your cholesterol
through diet and lifestyle, it may not be just less expensive but medically
more effective. Because the only side effects of diet and exercise are good
ones.

When you're out having fun, do you break your own rules?

It is hard for me ever to go out to dinner without people apologizing for
what they eat, or commenting on what I am eating. I don't care what you eat,
that is your business. But I indulge too. My particular indulgence is
chocolate.

Indulgences don't matter as much as your overall way of eating and living.
If you indulge yourself one day, eat healthier the next. The language of
behavior change has this moralistic quality -- I cheated on my diet
because I indulged myself. I am a bad person because I ate
bad food. That doesn't work, it only creates problems.